Comparison of Long-Term Survival of Patients with BCLC Stage B Hepatocellular Carcinoma after Liver Resection or Transarterial Chemoembolization

Abstract

Background and AimsTreatment of patients with Barcelona Clinic Liver Cancer Stage B hepatocellular carcinoma (BCLC-B HCC) is controversial. This study compared the long-term survival of patients with BCLC-B HCC who received liver resection (LR) or transarterial chemoembolization (TACE).MethodsA total of 257 and 135 BCLC-B HCC patients undergoing LR and TACE, respectively, were retrospectively evaluated. Kaplan–Meier method was used for long-term survival analysis. Independent prognostic predictors were determined by the Cox proportional hazards model.ResultsThe hospital mortality rate was similar between groups (3.1% vs. 3.7%; P = 0.76). However, the LR group showed a significantly higher postoperative complication rate than the TACE group (28 vs. 18.5%; P = 0.04). At the same time, the LR group showed significantly higher overall survival rates (1 year, 84 vs. 69%; 3 years, 59 vs. 29%; 5 years, 37 vs. 14%; P<0.001). Moreover, similar results were observed in the propensity score model. Three independent prognostic factors were associated with worse overall survival: serum AFP level (≥400 ng/ml), serum ALT level, and TACE.ConclusionsLR appears to be as safe as TACE for patients with BCLC-B HCC, and it provides better long-term overall survival. However, prospective studies are needed to disclose if LR may be regarded as the preferred treatment for these patients as long as liver function is preserved.

Liver resection for intermediate hepatocellular carcinoma

“…In accordance with these findings, several studies found similar survival benefits of liver resection in the management of intermediate HCC [24][25][26][27][28][29][30][31] . Another group of investigators performed a propensity score study which enrolled patients with intermediate and advanced HCC, and observed survival benefits of liver resection by total analysis and propensity-matched analysis [29] .…”

“…In recent years, many studies have validated the BCLC treatment recommendation [7,[18][19][20][21][22][23] . Liver resection has been widely performed in patients with intermediate HCC, and many investigators have argued that liver resection is as safe as TACE for intermediate HCC and provides better survival outcomes in selected patients [24][25][26][27][28][29][30][31] . Several centers have proposed their own criteria for judging which intermediate HCC patients are most likely to benefit from liver resection; Zhang et al [32] proposed that intermediate HCC cases with the following features should be considered for radical resection: Large or very large solitary tumor with swelling outward, clear border or pseudo-capsule, and less than 30% of the liver destroyed or more than 50% of hepatic hypertrophy; or multiple tumors limited to one segment or lobe.…”

“…Another group of investigators performed a propensity score study which enrolled patients with intermediate and advanced HCC, and observed survival benefits of liver resection by total analysis and propensity-matched analysis [29] . In addition, they conducted a subgroup analysis to detect whether patients with liver resection had better survival rates than those with TACE, and survival benefits were observed in subgroup analysis by tumor size, tumor number, macrovascular invasion, and portal hypertension.…”

Curative Intent Treatment of Hepatocellular Carcinoma - 844 Cases Treated in a General Surgery and Liver Transplantation Center

“…Patients were staged using BCLC system. BCLC stage B included patients without cirrhosis or with Child A or B cirrhosis with one lesion greater than 5 cm or 2-3 tumors (of which at least one was greater than 3 cm) in absence of vascular invasion or extrahepatic spread (11,12). The preoperative assessment of the tumor and liver function was performed.…”

Hepatic resection associated with good survival for selected patients with multinodular hepatocellular carcinoma

“…Although the recommendations of BCLC staging system are endorsed by the American Association for the Study of Liver Diseases (AASLD) [5] and the European Association for the Study of the Liver (EASL) [6], many large and qualified liver centers in treating HCC especially those in Asia do not subscribe to these guidelines. Some retrospective studies have demonstrated that HR is superior to palliative treatments for multinodular HCC [7][8][9][10]. Although these retrospective studies may have some unintentional selection bias, the first randomized controlled trial (RCT) by Yin and coworkers definitely support this conclusion [11].…”